Form 2-6(B)

If you wish to make a complaint or commendation concerning the actions of a Christiansburg Police Department employee or about any aspect of the Christiansburg Police operations, please complete this form. Alternate methods of making a complaint / commendation include: in person (at the Police Department at 10 East Main Street), by phone (382-3131), by mail (Chief of Police, Christiansburg Police Department, 10 East Main St., Christiansburg, VA 24073), or by e-mailing them directly to dramsey@christiansburg.org.

This form asks you to identify yourself and give specific details about the complaint/commendation. You will receive a letter from the Chief of Police acknowledging receipt of your submission and that an investigation has been initiated. It is possible that you may be contacted and asked additional questions. Once the submission has been investigated and reviewed, the Chief of Police will write you a letter explaining the outcome.

Section I- Employee Information

Incident Type:*

Complaint

Commendation

Employee Name:*

Assignment:*

Patrol Investigations Support Services

Communications Unknown

Section II- Citizen Information

Name:*

Social Security Number:

Date of Birth:*

Street Address 1:*

Street Address 2:

City:*

State:*

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Zip Code:*

Telephone:*

E-mail:*

Work Phone:

Other Phone:

Age:

Sex:

Male

Female

Place of Employment:

Street Address of Employment:

Street Address 2:

City:

State:

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Zip Code:

Section III: Incident Information

Date of Incident:*

Time of Incident:*

A.M./P.M.

A.M.

P.M.

Location:*

Street Address 1:*

Street Address 2:

City:*

State:*

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Zip Code:*

Details of Incident:*

Section IV- Witness Information

Witness #1 (if applicable):

Name:

Social Security Number:

Date of Birth:

Sex:

Male

Female

Age:

Street Adress 1:

Street Address 2:

City:

State:

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code:

Telephone:

Work Phone:

Other Phone:

Relationship:

Witness #2 (if applicable):

Name:

Social Security Number:

Date of Birth:

Sex:

Male

Female

Age:

Street Adress 1:

Street Adress 2:

City:

State:

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code:

Telephone:

Work Phone:

Other Phone:

Relationship:

By checking this box, I understand and acknowledge that any false, misleading, or untrue statements, accusations, or allegations made in relation to the employees of the Police Department may lead to civil or criminal sanctions.*